Lauren Sausser
For almost three years, Eric Tennant endured chemotherapy infusions, rounds of radiation, biopsies, and hospitalizations that left him weak and depleted.
“It’s good to be home,” he stated after one hospital keep in early June, “yet I’m tired and ready to get on with things.”
In 2023, Tennant, of Bridgeport, West Virginia, was identified with cholangiocarcinoma, a uncommon most cancers of the bile ducts that had unfold all through his physique.
None of the preliminary therapies prescribed by his medical doctors had eradicated the most cancers. But a glimmer of hope got here in early 2025, when Tennant was really helpful for histotripsy, a comparatively new process that will use ultrasound waves to focus on, and probably destroy, the most important tumor in his physique — in his liver.
“My dad was a little nervous because it was something new, but it definitely gave us some hope that he would be around a little bit longer,” stated Tennant’s daughter, Amiya.
There was only one hitch: His insurer wouldn’t pay for it.
Tennant, 58, died of most cancers on Sept. 17. His story illustrates how a bureaucratic course of referred to as prior authorization can devastate patients and their families.
It’s infeasible to depend the folks harmed by this overwhelmingly unpopular practice, which, by delaying or denying care, helps drive well being insurers’ earnings. No authorities company or personal group tracks such knowledge.
That stated, KFF Health News has heard from a whole bunch of sufferers lately who declare that they or somebody of their household has been harmed by prior authorization. More than 1 in 4 physicians surveyed by the American Medical Association in December stated that prior authorization had led to a severe hostile occasion for a affected person of their care. And 8% responded that prior authorization led to a incapacity, start defect, or demise.
In June, the Trump administration announced a pledge, signed by dozens of personal insurers, to streamline prior authorization, which frequently requires sufferers or their medical groups to ask insurers for permission earlier than continuing with many sorts of care. It stays unclear when sufferers can anticipate to see enchancment.
The commitments “depend on the full cooperation of the private insurance sector” and can “take time to achieve their full effect,” stated Andrew Nixon, a spokesperson for the Department of Health and Human Services. But the pledge exists, he stated, “to prevent tragic deaths like Eric’s from occurring at the hands of an inefficient system.”
Chris Bond, a spokesperson for AHIP, a medical health insurance business commerce group, stated he couldn’t converse to any particular insurer’s prior authorization insurance policies. Broadly, although, he stated prior authorization “acts as a guardrail” to ensure medicines and coverings aren’t used inappropriately.
At the identical time, he stated, insurers acknowledge that sufferers might be pissed off when their doctor-recommended care is denied. That’s why “there is a dedicated effort across the industry to make the process more straightforward, faster, and simpler for patients and providers,” Bond stated.
In the meantime, the method continues to take its toll on folks like Eric Tennant, whose grave diagnoses typically require costly well being care providers.
“Eric is gone,” his widow, Becky, stated. “He’s not coming back.”
Tennant was a security teacher for the West Virginia Office of Miners’ Health Safety and Training and insured by the state’s Public Employees Insurance Agency, which contracts with UnitedHealthcare to manage advantages for state staff, their spouses, and dependents.
In February and March, UnitedHealthcare, the Public Employees Insurance Agency, and an out of doors reviewer issued a sequence of denials that concluded Eric’s advantages wouldn’t cowl histotripsy, claiming the therapy was not medically obligatory. Becky Tennant estimated the process would price the household about $50,000 out-of-pocket.
Although the therapy wasn’t assured to work, it was price a shot, the Tennants thought, in order that they thought-about withdrawing cash from their retirement financial savings. But then, in May, after KFF Health News and NBC News posed a sequence of inquiries to UnitedHealthcare and the Public Employees Insurance Agency about Eric’s case, the company reversed course. PEIA determined to cowl his therapy.
Notably, the company contacted KFF Health News concerning the approval hours earlier than it notified the Tennant household of the choice.
But the approval got here too late. Eric was hospitalized in late May and prescribed medicine that prevented him from present process histotripsy at the moment. His household held out hope that his well being would enhance and he would qualify for the process that summer time.
In July, they took a household trip to Marco Island, Florida. It can be their final. Two days after they returned house, a scan revealed Eric’s most cancers had continued to unfold. Histotripsy was out of the query.
“I’m sad for what we will miss out on,” Becky stated. “I’m sad at the unfairness of it.”
She stated if Eric had been capable of endure histotripsy in February, as initially really helpful by his physician, it might need destroyed the tumor in his liver that finally killed him.
“We’ll never know. That’s the thing. Any lawyer for the insurance will say, ‘Well, you don’t know it would have helped.’ No. You took that chance away from us,” she stated.
In October, Samantha Knapp, a spokesperson for the West Virginia Department of Administration, informed KFF Health News that the Public Employees Insurance Agency has not modified its insurance policies associated to prior authorization for histotripsy and continues to observe UnitedHealthcare’s pointers.
UnitedHealthcare declined to reply questions for this text.
On Sept. 17, in a hospice mattress arrange of their eating room, Eric was surrounded by his household and their canine as he died. Becky held his hand as his coronary heart price started to drop.
“He wasn’t afraid to die, but he didn’t want to die,” she stated. “And you could tell the last day that he was fighting it big time.”
At the very finish, she whispered in his ear: “You know I love you. You have been the best husband and the best dad, and you’ve always taken such good care of us,” Becky recalled.
And then, she stated, he gasped. His eyebrows appeared to shoot up in marvel. During his final second alive, she stated, he smiled.
“The look on his face was pure, total amazement,” she stated. “I still can’t believe he’s not here.”
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